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There are some people I will never understand. Panda Bear is one of them.

It is only with some effort that I am able to ignore the bait of his snarky mischaracterization of "what liberals want," which is awesomely preceded by the disclaimer that "I like to avoid discussing politics as much as possible." But with effort I will do so, and address the substance of his argument, such as it is.

First of all, to give credit where it is due, I agree entirely with the first major part of this post, which addresses malpractice and the burden it places on medical care. Well written. I had some thoughts on that same issue today...

But then he goes on to make the bizarre and nihilistic argument that "The health care system in this country is not broken. It is a beautifully evolved creature, functioning perfectly, and exquisitely adapted to the political, legal, and economic environment in which it operates. In other words, every initiative to fix health care will be useless." He goes on to explain verbosely, that health care is expensive because, well, it's expensive and we consume a lot of it, and that the only way to control costs is to "put granny down."

It is, I must say, refreshing to hear a conservative so honestly endorse rationing as the necessary step towards controlling health care spending. Most of the current politicians prefer the easier laissez faire method of economic rationing, in which fifty or sixty million poor Americans just get no health care - it's easy because the market does it for us! But Panda takes the brave step of shifting the rationing to the real cost drivers - the old and infirm. Much more efficient, though politically problematic, and more difficult to accomplish because the medical system and the government would have to actively manage the rationing. Panda likes the straw woman of the demented nursing home patient (all too real) but she is not the sole, or even the largest disproportionate consumer of health care. Presumably he would also mean that we would cut off dialysis for, well, pretty much everybody, give up on organ transplantation, and have government bureaucrats sign off on compulsory DNR orders once you hit a certain point. Odd, I thought conservatives usually liked less government interference in health care.

I suppose it is possible, just possible, that Panda isn't really advocating euthanizing old people (I can't say that for sure, because he's ranted on this topic an awful lot). In which case, I am having a hard time getting his point. Yes, chronic care costs a lot of money, as does technologically advanced care. Across-the-board cutbacks in care are not likely. Spending 15% of the GDP on health care is probably not sustainable. So where are you going with this line of argument? The logical conclusion might be that we should have a more efficient health care delivery system in which there is, I don't know, a single payer which doesn't waste money on profits or executive compensation or marketing or redundant paperwork.... Is that really what you meant? Or maybe that we should have some centralized regulatory agency set cost-based standards on what services will be covered, like in the Oregon Health Plan? Or maybe we are just paying doctors too much? (I don't think so.)

At this point, none of us has a solution for the escalating cost of health care, at least not one that is simple and elegant and operational. But health care reform is necessary and inevitable (or so I sincerely hope), both for the purpose of bringing everybody into the system and for some form of cost containment. I guess for the moment we'll leave euthanasia as "plan B," and work towards some, er, more practical mode of reform.

Shadowfax, as he is known, works in a busy, high-acuity emergency department in the Pacific Northwest as an emergency physician and administrator. He is also interested in health policy and progressive politics. His various hobbies include shorin-ryu karate, violin (Irish fiddle, mostly), general aviation, Apple computers, craftbrewed beer, and skiing. "My kids do their best to ensure I have little time in which to pursue these hobbies."

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